World Institute of Pain – Board of Examination

Examination Application for Certification
as Certified Interventional Pain Sonologist
(CIPS)

INTRODUCTION
This application must be completed in its entirety. Attached, enclosed, or forwarded materials will not be accepted in lieu of this application. Supplemental documentation may be sent as identified in the following registration forms, or if later requested or required by WIP/BOE officials.

Since this application is quite lengthy, it is broken into 5 major sections and you can choose to complete one section at one sitting, save that section and then return at a later time to complete the next section(s). And you can repeat this process until the entire application has been completed. And you certainly can complete the entire application in one sitting if you so desire.

After you complete the 5 sections of the CIPS Application, the last steps of the process are as follows: 1) allows you to review your entire completed Application to make corrections/additions, if any; 2) has you make payment toward the CIPS Examination Fee of $2,500; and, 3) finally allows you to download a final copy of your entire CIPS Examination Application for printing and saving on your computer.

Before beginning this application process, there are a few items of information you should have handy and/or available as specified below to speed the process of completing the application.

  1. A small (2" x 3") digital photo in JPG format of the applicant, which bears the applicant's signature across the photo. You will upload this photo from your computer.
  2. Digital copies of all Medical Degrees in JPG format of the applicant (up to 3 degrees). You will upload this image(s) from your computer. NOTE 1: If the physical size of your license(s) is(are) larger than 8-1/2 by 11 inches (216 by 279 millimeters), make a reduced-size copy to 8-1/2 by 11 inches (216 by 279 millimeters) and make your digital copy JPG image from the reduced copy. NOTE 2: Many computer printers can scan photos and documents and convert them into JPG images stored on your computer.
    NOTE: You may choose to mail copies of your licenses (in lieu of uploading digital images) to the Certification Program Manager after you complete this on-line Application. His mailing address will be provided when you complete this CIPS Exam Application
  3. If you do not have a valid, unrestricted, and current license to practice medicine in your country, you do NOT meet the eligibility requirements for admission to the CIPS.
  4. If you are NOT currently board certified by a member of the ABMS or equivalent postgraduate medical specialty examination for country of practice, you do not meet the eligibility requirements for admission to the CIPS.
  5. To view the content of this entire CIPS application that follows, please click HERE. This will help you collect old information that may be needed for completing this on-line application.
 
LOGIN AND PASSWORD PROTECTED ACCOUNT CREATION:

It is necessary for every applicant to establish a Login account for security purposes and to accommodate the design of this application process for completing this application in multiple steps, even if an applicant completes the entire application in one sitting. In setting up this login account, your UserID will be your email address that you will use in entering your contact information in the application form. If multiple members of the same medical practice are expected to apply for this CIPS Exam, each applicant must use a unique email address, not the universal or generic office email address. You will choose your own password. Once you have created your secured login account, each time that you log in, this application will automatically determine at what step you are in the application process and will display the next section for your completion.

To continue and create your login account, please click "Create My Account" button below.

If you already have a login account, please click "Log In" below.
 
 

 

   CIPS™ Electronic Application
© 2016 World Institute of Pain